title: Dialysis and the elderly: an underestimated problem.
abstract: In developed countries, the incidence of end-stage renal failure is constantly increasing, and uremia will soon be a disease typically found in mature and elderly adults. Almost invariably, the physical condition of the elderly patient with terminal uremia is extremely poor, and therapeutic approach complex. Frequent co-morbidity, treatment with many different drugs, the high risk of iatrogenic damage, advanced age and socio-environmental conditions further complicate the management of these patients. While replacement therapy may become necessary, peritoneal dialysis may have advantages over hemodialysis. Peritoneal dialysis causes less hemodynamic stress, does not necessitate vascular access and allows mobility, although it incurs a high incidence of peritonitis and vascular disease. Where hemodialysis is the only feasible treatment, procedures used for vascular access are frequently followed by several complications, representing an important cause of morbidity and hospitalization. In addition, even if it may improve the patient's quality of life, vascular condition, intradialytic hypotension, heart disease, intestinal bleeding and amyloidotic arthropathy are critical aspects of dialysis in the elderly patient. Therefore, particular attention from clinicians and administrators is required and the best possible strategies must be identified in order to provide effective and appropriate services to address these special patients' needs.
authors.affiliation: Chair of Nephrology, Department of Internal Medicine, University of Messina, Messina, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Buemi
authors.forename: Antonio
authors.initials: A
authors.lastname: Lacquaniti
authors.forename: Davide
authors.initials: D
authors.lastname: Bolignano
authors.forename: Valentina
authors.initials: V
authors.lastname: Donato
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Fazio
authors.forename: Susanna
authors.initials: S
authors.lastname: Campo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Coppolino
authors.forename: Alessio
authors.initials: A
authors.lastname: Sturiale
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D006801:Humans; D010530:Peritoneal Dialysis / Q000009:adverse effects; D006435:Renal Dialysis / Q000009:adverse effects; D014511:Uremia / Q000150:complications / Q000628:therapy